Journal Articles
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Item Proposing a unified Mediterranean diet score to address the current conceptual and methodological challenges in examining adherence to the Mediterranean diet(Frontiers Media S.A., 2025-09-12) Hwalla N; Trichopoulou A; Delarue J; Adinolfi F; Brighenti F; Burlingame B; Capone R; Dernini S; El Moujabber M; González-Gross M; Vecchio Y; Massouh N; Naja F; Pederiva CA plethora of studies has documented the benefits of the Mediterranean diet (MedDiet) for both human and environmental health. At the core of these investigations lies the assessment of adherence to it. In this manuscript, we aim to examine existing original scores used to assess adherence to the MedDiet and propose a framework for a unified score to address current challenges and complement the existing scores. A literature search was conducted to identify original MED scores, excluding those derived from earlier scores. A total of nineteen original scores were identified and examined. At the conceptual level, across existing scores, the following issues were identified: inconsistencies in food items, lack of holistic lifestyle approaches with focus on food-based components, limited cultural specificity, absence of sustainability evaluations, and regional focus solely on economically developed countries. At the methodological level, the majority of scores were based on cutoffs set by the population-specific distributions of dietary intake. Such cutoffs may be in discordance with the dietary recommendations of the different food groups considered. In addition, the definition of “adherence” is inconsistent across the scores, making the interpretation and comparability of the prevalence of adherence another methodological challenge. As a result, a framework for a Unified Mediterranean diet Score (UMEDS) is proposed. This framework consists of 10 food groups (whole grains, fruits, vegetables, dairy products, fish, legumes, olive oil, nuts and seeds, poultry, and red meat). These food groups are the common denominators of a traditional Mediterranean diet. In addition to the food-related components, the UMEDS also addresses physical activity, sleep, conviviality, and culture-specific food consumption (mainly composite dishes based on olive oil). For each of these items, evidence-based cut-offs were proposed. The total score for the UMEDS ranges from 0 to 22 with higher scores indicating a higher adherence (≤12 poor adherence, 13–17 moderate adherence, ≥18 good adherence). By integrating key components of dietary intake, lifestyle habits, and cultural practices, the UMEDS provides a comprehensive unified approach that aligns with global health guidelines and reflects the true spirit of the Mediterranean diet, rooted in food, lifestyle, culture, lifestyle, and traditional knowledge and practices.Item Multi-scalar policy uptake of the six-dimensional food security framework(Elsevier Ltd, 2025-11-01) Clapp J; Moseley WG; Termine P; Burlingame BIn 2022, along with colleagues, we proposed a six-dimensional food security framework in a Food Policy viewpoint article that argued for the need to expand the commonly cited four pillar approach (availability, access, utilization and stability) by adding two additional dimensions: agency and sustainability. The proposal was not just for a new conceptual framework for scholarly analysis, but also for its application in policy settings. Over three years later, we are humbled to see widespread uptake of our call to embrace agency and sustainability as dimensions of food security in multiple tyles of policy settings at different scales. This brief policy comment outlines the growing recognition and application of the six-dimensional framework for food security in policy contexts from the global to the local level. We are hopeful that the growing application of this idea will help to make improvements in the global quest to end hunger.Item Global protein sustainability and the United Nations, through to the 2030 agenda(Frontiers Media S.A., 2024-10-15) Burlingame B; Moltedo A; Cafiero C; Hendriks WOrganizations and initiatives concerned with food security and nutrition have long positioned protein, together with dietary energy, as the keystone for life itself. Indeed, the word protein, derived from the Greek proteios, means ‘of primary importance’. There is a long history of attention to, and controversies over, proteins in UN processes, beginning in the 1930s and continuing to this day. The importance of protein for agriculture, health, food security and nutrition is reflected in the data collected and presented in the statistical databases of the Food and Agriculture Organization (FAOSTAT), available per commodity, per country and over an extensive time series. Protein features directly and indirectly in all 17 Sustainable Development Goals (SDG), which constitute the United Nations 2030 Agenda. Most directly involved is SDG 2. The short title for SDG 2 is ‘zero hunger’. The long title offers more detail: end hunger, achieve food security and improved nutrition and promote sustainable agriculture.Item Partnerships for the Sustainable Development Goals: a call for more science(Frontiers Media S.A., 2024-04-11) Berry EM; Burlingame B; le Coutre J; Nikolaou CKItem Guidance on the preparation and submission of the notification and application for authorisation of traditional foods from third countries in the context of Regulation (EU) 2015/2283 (Revision 1)(John Wiley and Sons Ltd on behalf of the European Food Safety Authority, 2021-03-26) EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA); Turck D; Bresson J-L; Burlingame B; Dean T; Fairweather-Tait S; Heinonen M; Hirsch-Ernst KI; Mangelsdorf I; McArdle HJ; Naska A; Neuhäuser-Berthold M; Nowicka G; Pentieva K; Sanz Y; Siani A; Sjödin A; Stern M; Tomé D; Vinceti M; Willatts P; Engel K-H; Marchelli R; Pöting A; Poulsen M; Schlatter J; Gelbmann W; de Sesmaisons-Lecarré A; Verhagen H; van Loveren HFollowing the adoption of Regulation (EU) 2015/2283 on Novel Foods, the European Commission requested EFSA to develop a scientific and technical guidance for the preparation and submission of notifications for traditional foods from third countries. This guidance presents a common format for the organisation of the information to be presented by applicant for the preparation of a well-structured dossier. The safety of a traditional food should be substantiated by reliable data on its composition, its experience of continued use and its proposed conditions of use. Its normal consumption should not be nutritionally disadvantageous. This guidance is also intended to support applicants in providing the type and quality of information EU Member States and EFSA need for the assessments of traditional foods from third countries. The applicant should integrate the information on the composition and the experience of continued use and provide a concise overall consideration on how this substantiates the history of safe use of the traditional food and how this relates to the proposed conditions of use for the EU. Where potential health hazards have been identified on the basis of the composition and/or data from the experience of continued use, they should be discussed. On the basis of the information provided, EFSA will assess the safety related to the consumption of the traditional food under the proposed conditions of use. This guidance was originally adopted by the NDA Panel in 2016. It has been revised in 2020 to inform applicants of the new provisions introduced by Regulation (EC) No 178/2002, as amended by Regulation (EU) 2019/1381 on the transparency and sustainability of the EU risk assessment in the food chain.It is applicable to allnotifications and applications submitted as of 27 March 2021. The 2016 version remains applicable to notifications and applications submitted before 27 March 2021.Item Viewpoint: The case for a six-dimensional food security framework(Elsevier Ltd, 2022-01-12) Clapp J; Moseley WG; Burlingame B; Termine PThe definition of food security has evolved and changed over the past 50 years, including the introduction of the four commonly cited pillars of food security: availability, access, utilization, and stability, which have been important in shaping policy. In this article, we make the case that it is time for a formal update to our definition of food security to include two additional dimensions proposed by the High Level Panel of Experts on Food Security and Nutrition: agency and sustainability. We show that the impact of widening food system inequalities and growing awareness of the intricate connections between ecological systems and food systems highlight the importance of these additional dimensions to the concept. We further outline the ways in which international policy guidance on the right to food already implies both agency and sustainability alongside the more established four pillars, making it a logical next step to adopt a six dimensional framework for food security in both policy and scholarly settings. We also show that advances have already been made with respect to providing measurements of agency and sustainability as they relate to food insecurity.Item Dietary agrobiodiversity for improved nutrition and health outcomes within a transitioning indigenous Solomon Island food system(Springer Nature BV on behalf of the International Society for Plant Pathology, 2021-08) Vogliano C; Raneri JE; Coad J; Tutua S; Wham C; Lachat C; Burlingame BIndigenous food systems of Pacific Small Island Developing Countries contain vast biological and cultural diversity. However, a nutrition transition is underway, characterized by shifts away from traditional diets in favour of imported and modern foods, contributing to some of the highest rates of obesity and Diabetes Type 2 Mellitus in the world. Using a mixed method approach, this study aimed to assess dietary agrobiodiversity’s relationship with nutrition indicators related to diet quality and anthropometrics within the context of the rural and Indigenous food system of Baniata village, located in the Western Province of Solomon Islands (Melanesia). A secondary aim was to evaluate the contribution of agrobiodiversity from the local food system to diet quality. A comprehensive nutrition survey was administered to the women primarily responsible for cooking of randomly selected households (n = 30). Additionally, 14 participatory focus group discussions captured the historical narrative of food system transitions, were hosted over a period of seven days, and included men, women and youth. Dietary intakes of the participants were reported below the estimated average requirement (EAR) for several essential nutrients, including protein (53%), calcium (96.6%), vitamin B1 (86.6%), vitamin B2 (80%), vitamin A (80%), zinc (40%) and fibre (77%). Focus group participants built a timeline of key historical and climatic transitions perceived to be drivers of dietary shifts away from traditional foods and towards imported and processed foods. Participants identified 221 species and varieties of agrobiodiverse foods available for cultivation or wild collection. Based on 24 h diet recalls, 87 were found to be utilised. Participants who consumed foods of a wider diversity of species richness had a higher probability of achieving recommended nutrition intakes and a lower body fat percentage (r2 = 0.205; p = 0.012). Our results suggest a nutrition transition is underway, and strategies harnessing traditional knowledge of nutrient-dense, agrobiodiverse foods can help improve food and nutrition security.Item Guidance on the preparation and submission of an application for authorisation of a novel food in the context of Regulation (EU) 2015/2283 (Revision 1)2(John Wiley and Sons Ltd on behalf of European Food Safety Authority, 2021-03-26) EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA) Products; Turck D; Bresson J-L; Burlingame B; Dean T; Fairweather-Tait S; Heinonen M; Hirsch-Ernst KI; Mangelsdorf I; McArdle HJ; Naska A; Neuhäuser-Berthold M; Nowicka G; Pentieva K; Sanz Y; Siani A; Sjödin A; Stern M; Tomé D; Vinceti M; Willatts P; Engel K-H; Marchelli R; Pöting A; Poulsen M; Salminen S; Schlatter J; Arcella D; Gelbmann W; de Sesmaisons-Lecarré A; Verhagen H; van Loveren HFollowing the adoption of Regulation (EU) 2015/2283 on novel foods, the European Commission requested EFSA develop scientific and technical guidance for the preparation and submission of applications for authorisation of novel foods. This guidance presents a common format for the organisation of the information to be presented by the applicant when preparing a well-structured application to demonstrate the safety of the novel food. It outlines the data needed for the safety assessments of novel foods. Requirements relate to the description of the novel food, production process, compositional data, specification, proposed uses and use levels, and anticipated intake of the novel food. Further sections on the history of use of the novel food and/or its source, absorption, distribution, metabolism, excretion, nutritional information, toxicological information and allergenicity should be considered by the applicant by default. If not covered in the application, this should be justified. The applicant should integrate the data presented in the different sections to provide their overall considerations on how the information supports the safety of the novel food under the proposed conditions of use. Where potential health hazards have been identified, they should be discussed in relation to the anticipated intakes of the novel food and the proposed target populations. On the basis of the information provided, EFSA will assess the safety of the novel food under the proposed conditions of use. This guidance was originally adopted in 2016.It has been revised to inform applicants of the new provisions introduced by Regulation (EC) No 178/2002, as amended by Regulation (EU) 2019/1381 on the transparency and sustainability of the EU risk assessment in the food chain. This revised guidance applies to all dossiers submitted as of 27 March 2021. The 2016 version of this guidance remains applicable to applications submitted before 27 March 2021.Item Goals in Nutrition Science 2020-2025(Frontiers Media SA, 2020-02-09) Bassaganya-Riera J; Berry EM; Blaak EE; Burlingame B; le Coutre J; van Eden W; El-Sohemy A; German JB; Knorr D; Lacroix C; Muscaritoli M; Nieman DC; Rychlik M; Scholey A; Serafini MFive years ago, with the editorial board of Frontiers in Nutrition, we took a leap of faith to outline the Goals for Nutrition Science - the way we see it. Now, in 2020, we can put ourselves to the test and take a look back. Without a doubt we got it right with several of the key directions. To name a few, Sustainable Development Goals (SDGs) for Food and Nutrition are part of the global public agenda, and the SDGs contribute to the structuring of international science and research. Nutritional Science has become a critical element in strengthening work on the SDGs, and the development of appropriate methodologies is built on the groundwork of acquiring and analyzing big datasets. Investigation of the Human Microbiome is providing novel insight on the interrelationship between nutrition, the immune system and disease. Finally, with an advanced definition of the gut-brain-axis we are getting a glimpse into the potential for Nutrition and Brain Health. Various milestones have been achieved, and any look into the future will have to consider the lessons learned from Covid-19 and the sobering awareness about the frailty of our food systems in ensuring global food security. With a view into the coming 5 years from 2020 to 2025, the editorial board has taken a slightly different approach as compared to the previous Goals article. A mind map has been created to outline the key topics in nutrition science. Not surprisingly, when looking ahead, the majority of scientific investigation required will be in the areas of health and sustainability. Johannes le Coutre, Field Chief Editor, Frontiers in Nutrition.Item Assessing Diet Quality of Indigenous Food Systems in Three Geographically Distinct Solomon Islands Sites (Melanesia, Pacific Islands)(MDPI (Basel, Switzerland), 2021-01) Vogliano C; Raneri JE; Maelaua J; Coad J; Wham C; Burlingame BIndigenous Solomon Islanders, like many living in Pacific Small Island Developing States (PSIDS), are currently experiencing the global syndemic-the combined threat of obesity, undernutrition, and climate change. This mixed-method study aimed to assess nutrition transitions and diet quality by comparing three geographically unique rural and urban indigenous Solomon Islands populations. Participants in rural areas sourced more energy from wild and cultivated foods; consumed a wider diversity of foods; were more likely to meet WHO recommendations of >400g of non-starchy fruits and vegetables daily; were more physically active; and had significantly lower body fat, waist circumference, and body mass index (BMI) when compared to urban populations. Urban populations were found to have a reduced ability to self-cultivate agri-food products or collect wild foods, and therefore consumed more ultra-processed foods (classified as NOVA 4) and takeout foods, and overall had less diverse diets compared to rural populations. Clear opportunities to leverage traditional knowledge and improve the cultivation and consumption of underutilized species can assist in building more sustainable and resilient food systems while ensuring that indigenous knowledge and cultural preferences are respected.